Bar Insurance Application - Humberview Insurance

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Bar Application

Submission of this information does not represent a binding of any insurance contract or agreement. Additional information may be required in order to get an accurate quote of insurance

Legal Name of Establishment
Your Name
First Last
Your Contact Number
Email
Website of Establishment
Years in Business or Years Experience in Hospitality Industry (if no prior years in business please describe your past managerial experience in hospitality industry)
Has The Establishment Ever Had an Insurance Claim?
YES: Date, Description of Loss and Amount of Loss ($)
Current Insurance Company
Property Details
Address of Establishment
Street Address City Province Postal Code
Building Year Built
Total Square Footage Restaurant Occupies
How Many Stories
Is There A Basement?
Is The Building More Than 80% Sprinklered ?
Building Construction
Exterior Walls
Other
Roof
Other:
Update Year
Plumbing
Update Year
Oher:
Electrical – WIRING
Update Year
Other Wiring
Electrical – Panel
Other Panel
Electrical – AMPs
Heating Source
Update Year
Other
Establishment Operations
Type of Establishment:
Annual Revenue from Food ($)
Annual Revenue from Alcohol($)
Is There Any Other Revenue Other Than From Food & Alcohol
Other Revenue ($)
Other – Describe Service or Goods Sold
In The Premises Is There A WETT Extinguishing System Which is ULC Compliant Fixed Fire Suppression System on Semi-Annual Maintenance Contract?
- Yes
- No
K-Type Fire Extinguisher Located in Kitchen ?
- Yes
- No
Is There Deep Fat Frying
- Yes
- No
Range, Hood, Ventilating Duct Work, Exhaust Fans and Filter Screens Steam Cleaned by Professional Company Semi-Annually ?
- Yes
- No
Do you Attend Any Fairs/Festivals/Events ?
- Yes
- No
Is The Premises Monitored by Central Alarm System?
- Yes
- No
Hours of Operation + Days Open Per Week
Number of Seats Inside
Number of Seats Outside
Number of Full Time Staff
Number of Part Time Staff
Any Deleveries Done?
Sales from Delivery $
Delivery Done By Employees or Third Party ?
Any Live Entertainment
Live Entertainment – YES – Please Describe:
Consent*
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